CHIP: Low-Cost Health Coverage for Children

1Why this matters

Children in working families are often uninsured not because no help exists but because their parents assume they earn too much. CHIP reaches families with incomes well above the Medicaid line, and in many states into the middle class. It covers the care children need most, including dental care, and enrollment is open all year. This guide explains who qualifies, what CHIP covers and costs, and how to apply. For how CHIP fits with Medicaid and other coverage, see our guide to Medicare and Medicaid.

2Who qualifies for CHIP?

• Age: under 19.
• Income: above your state's Medicaid limit for children but within its CHIP limit, which ranges from about 170 to 400 percent of the poverty line.
• Coverage: uninsured. Some states require a short waiting period if a child recently dropped private coverage, with exceptions such as job loss.
• Residence and status: living in the state, and a U.S. citizen or qualified immigrant. Many states also cover lawfully residing children without the usual five-year wait.

Children who qualify for Medicaid are enrolled in Medicaid instead, which covers children at higher incomes than adults in every state. Some states also use CHIP to cover pregnant women, or the unborn child, at incomes above their Medicaid limit.

Want to see what this could mean for your situation? Use our Medicaid eligibility calculator to check the Medicaid income test for your household; children qualify at higher incomes through Medicaid and CHIP than adults do.

3How CHIP and Medicaid fit together

Every state must cover children in Medicaid up to at least 133 percent of the poverty line, and many go higher; CHIP then picks up children above that line. States set up CHIP in one of three ways: as an expansion of Medicaid, as a separate program with its own name and rules, or as a combination. A family usually fills out one application and the state decides which program fits.

The difference matters in a few places. Medicaid rarely charges premiums and covers every service a child needs under its screening and treatment guarantee. A separate CHIP program may charge modest premiums or copays and sets its own benefit package, which must still include dental care.

4What does CHIP cover?

Coverage is designed for children and typically includes:

• Well-child visits, check-ups and immunizations.
• Doctor and specialist visits, emergency care and hospital stays.
• Prescription drugs, lab tests and X-rays.
• Mental and behavioral health services.
• Dental care, which every state's CHIP must cover, and vision care.

The exact benefits depend on the state's plan. States that run CHIP as part of Medicaid cover children's care under Medicaid's broader rules, including its screening and treatment guarantee for children.

5What does CHIP cost?

Many states charge no premium for CHIP. Where a state charges premiums, enrollment fees or copayments, federal rules generally cap a family's total costs at 5 percent of its income for the year. Well-child visits and immunizations are free, and American Indian and Alaska Native children pay no premiums or cost-sharing.

6How long coverage lasts

Since January 1, 2024, states must give children under 19 twelve months of continuous eligibility in both Medicaid and CHIP. Once enrolled, a child generally keeps coverage for a full year even if family income rises or falls, with limited exceptions such as moving out of state or turning 19.

If your income falls during the year, report it anyway: a child in CHIP may be able to move to Medicaid, which can lower costs further. At renewal, the state checks eligibility again, often using information it already has. Read every renewal notice and return forms on time, because a missed renewal is a common reason children lose coverage.

7Special situations

If a parent has job-based coverage

Children with other health insurance generally cannot enroll in CHIP. But if covering the family through a parent's job is too expensive, family members may now qualify for Marketplace subsidies based on the cost of family coverage, and some states help pay employer premiums for eligible children.

Children with disabilities or special health needs

Children with significant disabilities may qualify for Medicaid regardless of their parents' income through SSI or state options that look only at the child's income, which can cover more services than CHIP. Ask the state about these routes.

Pregnancy and new babies

Some states use CHIP to cover prenatal care, and nearly all states now cover new mothers for 12 months after birth through Medicaid or CHIP. A baby born to a mother covered by Medicaid or CHIP is generally covered for the first year.

8How to apply

You can apply any time of year, not just during Marketplace open enrollment. Apply through your state's Medicaid or CHIP agency, or through HealthCare.gov, which checks whether a child qualifies for Medicaid, CHIP or a Marketplace plan and sends the application to the right place. For help finding where to apply, call 1-800-318-2596 or visit InsureKidsNow.gov.

Have the household's income information, Social Security numbers or immigration documents for those applying, and the children's birth dates ready. A parent does not have to give their own immigration status to apply for a child. Some states use express lane eligibility, enrolling children based on information from SNAP or school meal records. If a child loses other coverage, apply right away; see our guide to special enrollment periods for the rest of the family.

9Common mistakes

• Assuming the family earns too much without checking the state's CHIP limit.
• Waiting for Marketplace open enrollment, when CHIP takes applications all year.
• Missing the renewal notice and losing coverage at the end of the 12 months.
• Not applying for children because a parent is not eligible or is worried about their own status.

11What this does not tell you

Income limits, premiums and covered services are set by each state and change over time. Your state agency or Medicaid.gov has the current figures.

Eligibility for immigrant children depends on their status and on which options the state has chosen, which this guide does not set out in detail. Our calculator checks the adult Medicaid income test, not CHIP.